Donation Request Form

Submitting this form does not guarantee pickup. Our staff will contact you directly to confirm your donation and pickup availability. If you have any issues submitting your donation request, please email Kent@llhfh.org directly.

Your Name(s) (required)

Address (required)

Zipcode (required)

Phone(required)

Email(required)

Have you traveled outside of the United States in the past 30 days?
yesno

If yes, have you traveled to China, Japan, Italy, Iran, or South Korea?
yesnono international travel

Have you had contact with a person with COVID-19?
yesno

Have you had fever, shaking, chills, and/or sweats?
yesno

Do you have any cough or other cold symptoms or shortness of breath?
yesno

Please attach photo(s) of the items you wish to donate.

Please describe the item(s) you'd like to donate